Individual provider Active NPI

Mary Katherine Horner, PA-C

  • Physician Assistant
  • Lewes, DE
National Provider Identifier
1366803645
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0001050 Issued in DE
Practice address
33672 Bayview Medical Dr FL 1
Lewes, DE 19958-1687
Phone
(302) 645-2437
Fax
(833) 629-0820
NPI assigned
Mar 14, 2016
Last updated
Nov 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0001050 DE Primary

Addresses

Primary practice location

33672 Bayview Medical Dr FL 1
Lewes, DE 19958-1687

Mailing address

33672 Bayview Medical Dr FL 1
Lewes, DE 19958-1687
Phone (302) 645-2437

Other identifiers 1

IdentifierTypeStateIssuer
103366963001MedicaidPA

Other names 1

  • Mary Katherine Green Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160406000078 DE Practitioner - Physician Assistant 0840598959 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delaware Neurosurgical Group, PAGroup PAC ID 1557300431, 24 clinicians

Practice addresses (Care Compare)

18947 John J Williams Hwy
Unit 311
Rehoboth Beach, DE 19971-4477
Phone (302) 366-7671

774 Christiana Rd
Suite 202
Newark, DE 19713-4221
Phone (302) 366-7671

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C5-0001050DEMDPhysician Assistant

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1366803645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33672 BAYVIEW MEDICAL DR FL 1",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199581687",
            "telephone_number": "302-645-2437",
            "fax_number": "833-629-0820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33672 BAYVIEW MEDICAL DR FL 1",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199581687",
            "telephone_number": "302-645-2437",
            "fax_number": "833-629-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORNER",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-14",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0001050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103366963001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "GREEN",
            "middle_name": "KATHERINE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lewes, DE

Sources for this page

Verify at the official NPI Registry.